REF

Rendering Provider Identification

Pos: 040	Max: 10
Detail - Optional
Loop: 2100	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

REF01

128

Reference Identification Qualifier
Description: Code qualifying the Reference Identification

M

ID

2/3

Required

Code

Name

1A

Blue Cross Provider Number

1B

Blue Shield Provider Number

1C

Medicare Provider Number

1D

Medicaid Provider Number

1G

Provider UPIN Number

1H

CHAMPUS Identification Number

D3

National Association of Boards of Pharmacy Number

CODE SOURCE:

307: National Association of Boards of Pharmacy Number

G2

Provider Commercial Number

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Rendering Provider Secondary Identifier

C

AN

1/30

Required

ExternalCodeList

Name: 307

Description: National Association of Boards of Pharmacy Number

1.

R0203 - At least one of REF02,REF03 is required

1.

REF04 contains data relating to the value cited in REF02.

Notes:

1. This REF segment should be used to provide reference numbers that are not already identified in NM1 segments within the CLP loop. The NM1 segment should always contain the primary reference number. This segment should only be used when additional reference numbers were submitted on the original claim.

Example:

REF*1C*12345678~